Improving the quality of family planning and reproductive tract infection services for urban slum populations: Demand-based reproductive health commodity project

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. Service providers were trained to follow standard screening criteria and informed counseling so that clients can select an appropriate contraceptive method. They were also sensitized to counsel clients by using the “life cycle approach” with emphasis on long-term and permanent methods for women who have completed their family size. The aim of this study was to test a service delivery model for client-centered FP and RTI services to improve the reproductive health of couples living in urban slums

Support for research, dissemination, utilization, and policy in Bangladesh

Through the initiative of the Family Planning Fortnight: Meeting the Future Challenges, held in December 1993, the Government of Bangladesh made a policy statement about the critical importance of dealing with the nation\u27s population problem. The Fortnight provided the strategic framework for developing actions to strengthen the National Family Planning Program that would meet the country\u27s population challenges. To initiate rapid action, the Family Planning Fortnight Steering Committee, under the chairmanship of the Secretary, Ministry of Health and Family Welfare, formed a working group to prepare a report that would capitalize on all earlier efforts and lay out a plan of action. The working group identified a number of priority areas requiring immediate action to regain the momentum of the National Family Planning Program, and to ensure success in meeting the government\u27s demographic, social, and economic goals. The working group recognized that there are a number of long-term, strategic policy issues that also require quick attention. As noted in this report, efforts to increase the dissemination and utilization of research results for policy formulation have been productive in Bangladesh from the perspective of the government, NG0s, and donors

Strengthening RTI/STD services: Lessons learned from a pilot project

The national family planning and maternal child health (FP-MCH) program in Bangladesh has raised FP acceptance among couples of reproductive age significantly. A major challenge still facing the program, however, is strengthening its reproductive health (RH) component. The Population Council launched a pilot project to examine the feasibility of strengthening comprehensive reproductive tract infection (RTI) and sexually transmitted disease (STD) services at the Health and Family Welfare Center level. The project had three phases. First, a needs assessment was conducted. Then the components of the intervention were identified, designed, and implemented. And at the third phase, an evaluation was carried out. During the needs assessment phase, a feasibility study and a baseline survey were conducted. In the process, valuable experiences were gained with regard to RTI/STD service delivery at the primary level of the GoB service delivery system. The findings in this report suggest that the RTI/STD service component in the existing FP-MCH service delivery system can be strengthened without making any major changes in the program

Strengthening union level facility for providing normal delivery and newborn care services: Workshop report

In Bangladesh, a network of government health facilities providing maternal and child health services has been established. In rural areas, first-level fixed-facility service is provided at the union level through Health and Family Welfare Centers (HFWCs). These facilities are designed to improve maternal and child health by making services available to the people in rural areas, however a full range of reproductive health services for women is not available in those facilities. At present, no evidence exists to support whether or not HFWCs can safely and cost-effectively provide normal deliveries. There is a need for a policy research initiative that can draw upon concrete evidence to support the policy changes necessary for strengthening HFWCs so they can provide normal delivery and newborn care services. With financial support from the UK Department for International Development (DFID), the Population Council has undertaken a policy and systems study aimed at identifying possible mechanisms for strengthening HFWCs so that they can provide normal delivery and newborn care services. A workshop was organized at the onset of this study, and findings from that workshop are presented in this report

Innovative financing through pay-for-performance for providers to improve quality of care in Bangladesh: Transforming research into action

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to decide in what capacity the performance-based financing program should continue. The government needs to prepare itself to continue performance-based incentive programs in pursuance of achieving the MDGs of reducing maternal and neonatal mortality

Health systems and maternal mortality, neonatal mortality and child health: Review of selected service delivery models

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality in five selected developing countries, and to identify the strengths and limitations of these models. The countries studied, Bangladesh, Cambodia, Ghana, Tanzania, and Pakistan, were selected according to level of maternal and infant mortality, initiatives undertaken in the health sector to improve maternal and child health, and level of progress toward achieving the health-related Millennium Development Goals. Based on a set of selection criteria, several successful service delivery models implemented in the selected countries have been identified

Strengthening health and family planning services in low performing and hard-to-reach areas of Bangladesh: Workshop report

Although Bangladesh has established a comprehensive physical infrastructure to deliver health and family planning services with a network of primary health care facilities in rural areas, the impact of this health service network has been much less than expected because services do not reach all regions effectively. Two divisions, Sylhet and Chittagong, remain the most disadvantaged in terms of health and population outcomes and access to services, compounded by poor utilization of facilities in these areas. Moreover, the current health and population sector programs are beset with human resources and infrastructural problems. The Population Council organized a workshop to find answers to a key question: how can service delivery be improved in low-performing and hard-to-reach areas. This report shows that the workshop’s objectives were to: review current and emerging health and family planning issues particularly in low-performing and hard-to-reach areas; identify areas of deficiency in service delivery; and develop strategies for improving the performance of the health and population sectors in low-performing and hard-to-reach areas. Discussions were centered on human resources and infrastructure; behavior change communication and advocacy; and supplies and logistics

Maternal health commodity landscaping exercise: A snapshot of the Bangladesh program

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders to implement the UN Commission’s recommendations in conjunction with this assessment’s findings. This assessment validated the availability of the 13 commodities in three districts at district, subdistrict, and community levels, and within drug stores, in 15 government facilities and 27 private drug stores. Key stakeholders were consulted. A national workshop stimulated discussion, identified national priorities and information gaps, and identified areas requiring policy review. This stakeholder engagement helped identify opportunities for organizations’ contributions to implementing the recommendations

Introduction of emergency contraceptive pills in the public health system of Pakistan: A south-to-south collaboration

This report describes a south-to-south collaboration to assist the Ministry of Health of Pakistan to introduce emergency contraception (EC) into its family planning program, supported by the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program. The collaboration consisted of a three-day visit by senior managers from the Pakistani health authorities to Bangladesh to familiarize them with the EC program in that country, followed by a two-day consultative meeting in Islamabad to draw up concrete plans for introduction of the method into the Pakistan system. Participants at the consultation developed plans to introduce EC into both community-based distribution and clinical programs. The plans included staff training; commodity logistics; and development of information, education, and communication materials, many of which will be adapted from materials used in other EC projects in the region supported by FRONTIERS. The activity successfully met its goals. Providing south-to-south technical assistance was demonstrated to be an effective strategy for introducing sensitive services and is recommended for other regions and similar services

Ensuring community participation in MCH/FP activities: Lessons learned from a pilot project

Family planning (FP) and maternal and child health (MCH) in Bangladesh have achieved commendable success in the recent past, mostly through a large-scale government service-delivery system supported by donors and nongovernmental organizations. Although encouraged by this success, there was concern about programmatic, financial, and social sustainability of the program, including quality of services. It is now believed that most of these concerns will be taken care of if effective community participation can be ensured. A pilot project was initiated in 1997 in Anowara, a low-FP-performing area in rural Chittagong, with assistance from the Population Council. The main objective of the project was to develop a strategy to ensure community participation in the FP-MCH program and to document the process. This report notes that community members became more aware of the population problem and came to know about existing service facilities and the role of various stakeholders, including themselves. As a result of the intervention, the demand for services increased and most of the service providers were responding positively to the growing demand